بررسی سرانجام رزکسیون و آناستوموز اولیه‌ی کولون چپ در بیماران اورژانسی در ١٠ سال گذشته در بیمارستان الزهرا (س) اصفهان

نوع مقاله : مقاله های پژوهشی

نویسندگان

1 استادیار? گروه جراحی? دانشکده ی پزشکی? دانشگاه علوم پزشکی اصفهان? اصفهان?ایران

2 دانشجوی پزشکی، دانشکده‌ی پزشکی و کمیته‌ی تحقیقات دانشجویی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

چکیده

مقدمه: اعمال جراحی که به طور اورژانسی در بیماری‌های انسدادی بر روی کولون چپ انجام می‌شود اغلب دو مرحله‌ای هستند، یعنی ابتدا برای بیمار کولستومی تعبیه می‌شود و سپس عمل ترمیم در مرحله‌ی بعدی انجام می‌شود. در این مطالعه عوارض درمانی عمل یک مرحله‌ای یعنی رزکسیون و آناستاموز اولیه‌‌ی هم‌زمان، بررسی شد.روش‌ها: در یک مطالعه‌ی گذشته‌نگر پرونده‌ی بیمارانی که به طور اورژانسی با ولولوس سیگمویید، سرطان کولون چپ و پارگی‌های کولون ناشی از تروما به بیمارستان الزهارا (س) مراجعه کرده بوند، بررسی شد. عوارض درمانی در بیمارانی که جراحی رزکسیون و آناستوموز اولیه‌ی اورژانسی داشتند مورد بررسی قرار گرفتند.یافته‌ها: 109 بیمار مبتلا به انسداد کولون چپ شامل 25 نفر (9/22 درصد) با سرطان کولون چپ و 16 نفر (7/14 درصد) با پارگی‌های ناشی از ترومای کولون چپ و 68 نفر ( 4/62 درصد) نفر با ولولوس سیگمویید بودند. از این 109 بیمار، 46 بیمار (2/42 درصد) تحت رزکسیون و آناستوموز اولیه، 25 بیمار (9/22 درصد) تحت ریداکشن و 38 بیمار (9/34 درصد) تحت کلوستومی قرار گرفتند. میانگین سنی افراد در ولولوس سیگمویید 58 سال، سرطان کولون 62 سال و تروما 23 سال بود. در ولولوس سیگمویید از 30 بیمار که تحت رزکسیون و آناستوموز اولیه قرار گرفتند 5 بیمار (7/16 درصد) فوت کردند و طبق اطلاعات موجود در پرونده‌ها 25 بیمار در قید حیات، عفونت زخم، آبسه و لیک از آناستوموز پیدا نکردند. فقط 1 بیمار (4 درصد) جراحی مجدد داشت. در سرطان انسدادی از 12 بیمار با رزکسیون و آناستوموز اولیه، 4 بیمار (3/33 درصد) فوت کردند و از 8 بیمار در قید حیات 1 بیمار (5/12 درصد) دچار عفونت زخم و 1 بیمار (5/12 درصد) مبتلا به آبسه‌ی داخل شکمی شد و لیک از آناستوموز وجود نداشت. 5 بیمار (5/62 درصد) نیز نیاز به جراحی مجدد داشتند. در تروما از 4 بیماری که تحت رزکسیون و آناستوموز اولیه قرار گرفتند عوارض درمانی و عود جراحی و مرگ و میر وجود نداشت.نتیجه‌گیری: با توجه به نتایج به دست آمده، عمل یک مرحله‌ای کولون چپ از عوارض قابل قبولی برخوردار می‌باشد و چون بسیاری از عوارض عمل دو مرحله‌ای خود به خود حذف می‌شود برای درمان بیماران انسداد کولون چپ پیشنهاد می‌شود.

کلیدواژه‌ها


عنوان مقاله [English]

Results of Left Colon Primary Anastomosis in Emergency Colon Disease from 1998 to 2008 in Alzahra Hospital, Isfahan, Iran

نویسندگان [English]

  • Behnam Sanei 1
  • Mohsen Mahmudieh 1
  • Fahimeh Khademolhoseini 2
1 Assistant Professor, Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 Student of Medicine, School of Medicine And Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
چکیده [English]

Background: Traditionally, left colon obstruction is managed by a multistage defunctioning colostomy and resection. This paper presents the complications of single stage operation on a series of patients managed by primary anastomosis.Methods: In this retrospective study with the use of the patients file we gained the number of emergency patients, the number of patients under emergency sigmoid volvolus and left sided colon obstructive cancer, and left-sided colonic lacerations caused by the trauma. Complications of patients who had emergency resection and anastomosis surgery were studied.Findings: 109 patients were afflicted with left-sided colon obstruction, 25 patients (22.9%) had left sided colon obstructive cancer, 16 patients (14.7%) left sided colon lacerations caused by trauma, and 68 patients (62.4%) had emergency sigmoid volvolus. Of the 109 patients, 46 patients (42.2%) underwent resection and primary anastomosis, 25 patients (22.9%) reduction, and 38 patients (34.9%) underwent colostomy. The average age of sigmoid volvolus was 58 years, left sided colon obstructive cancer 62 years, and left-sided colon lacerations caused by trauma was 23 years. In sigmoid volvolus of the 30 patients who underwent resection and primary anastomosis 5 died (16.7%). According to the existing information, of the 25 living patients no one had wound infection, abscess, anastomotic leakage, and only 1 patient (4%) had a second surgery. In left-sided colon obstructive cancer, of the 12 patients who underwent resection and primary anastomosis 4 patients died (33.3%), and from the 8 living patients only 1 patient had (12.5%) infection wound and 1 patient (12.5%) had abscess, no patients had anastomotic leakage, and 5 patients (62.5%) need second surgery. In left-sided colon lacerations caused by trauma the 4 patients had no complications, and there were no deaths. Conclusion: Regarding the results of this study it can be concluded that left colon primary anastomosis can be performed safely in selected patients with acute obstruction of left colon. 

کلیدواژه‌ها [English]

  • Obstruction
  • Primary anastomosis
  • Left colon
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